Author: NRS Lifespan

Visual processing deficits are common sequelae in individuals who have sustained a brain injury.  Visual processing includes the acquisition of visual information and the appropriate use and manipulation of that information based upon task or environmental demands.  Following brain injury, visual processing deficits can manifest in various ways, and will likely interfere with the patient’s progress and rehabilitation outcome.

Vision is the most important sensory system that humans use to obtain information about the surrounding environment.  The visual system consists of the eyeball, the optic nerve, and several areas of the brain, which interact in complex ways that are currently only partially understood.  Many people use the term “visual perception” to describe how the visual system operates, although the actual process of visual perception enables us to make sense of information processed by this sensory system.

There are a large number of identifiable visual processing skills operating within the visual system, and there have been several attempts to describe them in some kind of rational framework.  These include the Deficit Skill Approach, which categorizes visual processing into specific deficits, and the Information Processing Models, which describe the reception, organization, and assimilation of visual information on a continuum from simple to complex.

The rehabilitation of visual processing deficits begins once the visual assessment is completed and specific deficits are identified.  Treatment can be multi-disciplinary and be provided by a variety of professionals including optometrists, neuropsychologists, and vision, cognitive, and occupational therapists.  As with other areas of cognitive rehabilitation, there are two broad approaches to the treatment of visual processing deficits: adaptive and remedial.  Utilizing these approaches in combination may result in the most successful rehabilitation outcome.  Adaptive treatment is provided in activities of daily living (ADLs).

It is well documented that visual processing deficits are a common problem following brain injury.  The impact of these deficits is likely compounded by associated or coexisting problems along with cognitive, behavioral, psychological, and medical conditions.  Proper and comprehensive visual assessment is vital in identifying potential visual deficits.  Once these deficits have been identified, visual (cognitive) rehabilitation strategies can be implemented.  Undoubtedly, effective treatment and rehabilitation for visual processing deficits will result in improved functional adaptation, better rehabilitation outcomes, and a more favorable prognosis.

For additional information or to schedule a consultation, please contact our office at 732-988-3441.

Michael J. Raymond, Ph.D., ABN, FACPN
Board Certified Neuropsychologist #232
Licensed Psychologist #35S100252900

When we think, we time travel. If we are not present, then we are either thinking about the past or the future. These are the three psychological time zones: Past, Present, and Future. Being aware of what “Time Zone” you are in—i.e. Past, Present, or Future–is an important first step in controlling maladaptive thoughts and behaviors. There are appropriate times to be present, to reflect, and to imagine. First, we must establish if we are in the appropriate zone.

I once heard on the radio an excellent metaphor to better explain this point. Imagine your zones as though it were a car. A car is designed with a very large front windshield for optimal visibility. There are also small rear-view and side-view mirrors to see either yourself or things behind you. When we drive, we want to spend most of our time looking at the things directly in front of us and a little bit ahead. If we look too far down the road, our view is obstructed, and it would be dangerous to focus on things you can’t yet see for excessive periods of time. If we spend all our time looking behind us, then we never see where we are going.

We should strive to spend most of our time being present (through the windshield). Thinking about the past is not necessarily bad; who doesn’t like sitting with friends over an old photo album or rehashing memories? History teaches us to learn and adapt. However, if we don’t take away lessons from our past, we can find ourselves cycle of negative thoughts and behaviors.  Therefore, learn from past but be present focused. Regarding future thinking, it’s critical to plan. But, to worry and try to look beyond what we can anticipate will increase anxiety and reactive stress. By being aware of “your time zone” and adjusting to your thought process, we can improve both your feelings and behaviors.

To summarize:

1) Mindfully establish your zone

2) Evaluate if it’s helpful in the moment

3) Shift if not appropriate time zone

3) Adjust if engaging in a time zone in a maladaptive manner (i.e. negative self-talk about a mistake we made)

4) Practice daily mindfulness exercise to help improve awareness

George Corradino, LPC
Professional Licensed Counselor

About 20% of adults in the U.S. experience chronic pain every day or almost every day. Chronic pain is different from acute pain. Acute pain resolves typically within twelve weeks. Chronic pain persists either beyond twelve weeks or the expected time for healing. Chronic pain is often secondary to traumatic injury or medical conditions like diabetes, cancer, etc. Examples of neurological disorders accompanied by chronic pain include multiple sclerosis, stroke, Parkinson’s disease, etc. Most commonly, chronic pain can affect your back, hips, knees, feet, head, etc.

A variety of factors influence the severity and time course of pain. According to the U.S. Pain Foundation, older age, gender, genetics, history of having surgery, being overweight, and stress- and trauma-related psychological conditions can have an influence on pain.

Your brain is primarily responsible for pain perception on biological and psychological levels. Since pain is unpleasant, the awareness of pain contributes to its interpretation as a threat of actual or potential damage occurring to the body. Not surprisingly, this interpretation results in increased stress, leading to elevations in anxiety, irritability, problems with thinking, fatigue, sleep disturbances, and other psychological and neuropsychological symptoms. Depression and anxiety are psychological conditions that affect people with chronic pain bidirectionally. For example, chronic pain can lead to depression and vice versa.

The current recommended treatment of chronic pain includes a combination of pharmacological interventions, no-pharmacological interventions, and psychological treatment. The types of psychological treatment used for patients with chronic pain may include Medical Adjustment Counseling®, Biofeedback therapy, Physical therapy, etc.

Here at NRS|Lifespan, our comprehensive team offers a unique approach to treating chronic  pain via Medical Adjustment Counseling® (MAC). MAC® is a specialized, counseling approach that is tailored to the individual’s unique health needs.  The goal is to improve coping skills, understand your medical condition, and learn to apply practical strategies to deal with your chronic pain.

For more information, please call our office.

Eleonora Gallagher, Psy.D.
Neuropsychology Post-Doctoral Fellow
NJ Permit: TP# 213-079

References

1. Hadjistavropoulos, T., & Craig, K. D. (2004). Pain: psychological perspectives. Psychology Press.
2. Johnson M. I. (2019). The Landscape of Chronic Pain: Broader Perspectives. Medicina (Kaunas, Lithuania), 55(5), 182. https://doi.org/10.3390/medicina55050182
3. Yong, R. J., Mullins, P.M., & Bhattacharyya, N. Prevalence of chronic pain among adults in the United States. PAIN: February 2022 – Volume 163 – Issue 2 – p e328-e332doi: 10.1097/j.pain.0000000000002291
4. www.uspainfoundation.org

Balancing caregiving with work and other family obligations can be stressful. Don’t overlook the stressful impacts of caregiving. It is important to reassess your loved one’s needs periodically – and your ability to provide care. It is important to get help and relief from the stress of caregiving. These tips can help you find the support you need:

1.     Ask for help: a) make a list of ways others can help, b) ask a friend or relative to help out for an hour each week, and c) don’t wait for a crisis, ask for and accept help on a regular basis.

2.     Take time for yourself: a) consider using respite care, homecare, or adult day care, b) schedule regular time for yourself, and c) plan to spend an hour each day or an afternoon once a week away from caregiving.

3.     Express your feelings and avoid isolation: a) recognize that feelings of frustration, sadness, anger, and depression are common under the circumstances and b) join a caregiver support group.

4.     Take care of your health: a) make sure to eat and rest, b) get moving, even 10 minutes of exercise a day can help, c) learn and use stress reduction techniques (visualization, meditation, breathing exercises), and d) don’t put off your own medical care.

5.     Learn about the condition: a) find out about different forms and stages of dementia so that you are not taken by surprise when new behaviors occur and b) if you can, provide information to family and friends so they will know how best to support you.

6.     Look for signs of burnout: Not taking care of your own health? Feeling lonely? Crying or losing your temper more than usual? These are all signs that you may need help.

Remember, you will be better able to care for another if you don’t take time for yourself. No one can do it all. You have to be your first priority.

Additional information and resources for caregivers:

• Community Resource Finder
•  Ways to Manage Stress & Be a Healthier Caregiver
• Caregiving for Dementia: What to Expect
• Caregiver Education & Training Videos
• Caregiver’s Guide to Managing Challenging Dementia Behavior
• Family Caregiving Guide
• Relaxation Techniques: Steps to Reduce Stress

Michelle Blose, PsyD
Neuropsychology, Post-Doctoral Fellow
NJ Permit: TP# 203-032

PMT stands for Parent Management Training. PMT is a type of evidenced based counseling designed to help parents observe, cultivate curiosity and improve understanding of their child’s behaviors.  The goal of PMT is to develop techniques to help your child or adolescent manage their emotions and behaviors.

All behaviors have meaning!

In PMT, the psychologist and parents work together to develop a tailored approach that works best for your specific family’s needs and goals. As a parent, you will be acting, as the therapist in your home to help support your child, learn to anticipate challenges, and problem solve or apply skills effectively.  On average, a course of PMT counseling ranges from 11-15 sessions, but may be longer depending on response to intervention.

Why PMT?

•   PMT is effective for learning strategies to help children with ADHD, Autism, Mood Disorders, Anxiety Disorders, etc.
•   PMT can improve academic skills, executive functioning, behaviors in home and classroom, improve social skills, and assist in activities of daily living.
•   PMT is effective in improving parent-child relationship and reducing arguments.
•   Help troubleshoot parenting woes and receive guidance on typical parenting issues.
•   PMT can help sibling relationships and improve the ‘family culture’.

If you have any questions, please contact our office.

Tali Frankfort, PsyD
Neuropsychology Postdoctoral Fellow
NJ Permit #213-056

By Dr. Scott Mathias
ABN Committee Chair

In  the most recent publication from The American Board of Professional Neuropsychology (ABN) (summer 2022), NRS|LS was chosen as a featured training site through the Academy of the American Board of Professional Neuropsychology (AABN) for exceptional training experience in neuropsychology.

The following was taken from the publication,

“Every so often we like to feature one of our AABN sites to highlight the exceptional training experiences in neuropsychology being offered through AABN. Neuropsychology Rehabilitation Services|LifeSpan (NRS|LS) in Tinton Falls, New Jersey has been an approved AABN site since 2015. Neuropsychology Rehabilitation Services|LifeSpan is a joint practice consisting of a neuropsychological rehabilitation program, a multi-specialty health psychology program and a behavioral health program treating a variety of mental health conditions. The Director of Training is Robert Sica, PhD, ABN, FACPN, though he has a partner, Steven Greco, PhD, ABN, as well as another neuropsychologist, Michael Raymond, PhD, ABN, who contribute to the neuropsychology training experience. Dr. Sica was the first clinical neuropsychologist on staff at Jersey Shore University Medical Center, Neuroscience Division, and Riverview Medical Center, both hospitals part of Hackensack Meridian Health. Dr. Sica has academic affiliations with Rutgers-Robert Wood Johnson Medical School and Seton Hall – Hackensack Meridian School of Medicine. He has expertise in brain injury rehabilitation. He developed an APA approved internship program in neuropsychology. He also provides legal/forensic neuropsychological support in judicial settings at a state and local level. Dr. Sica obtained his first board certification in neuropsychology in 1984 from the American Board of Professional Neuropsychology, and his second in 1992. Through his wealth of experience in the field of neuropsychology, Dr. Sica and the ABN post-doctoral training program at Neuropsychology Rehabilitation Services|LifeSpan offer neuropsychological residents a broad and enriching professional experience with a predominant focus upon the clinical application of neuropsychology in the community.”

Weight loss is consistently identified as a major health-related goal of many Americans, and yet, many fail to have sustained success in both losing weight and keeping it off. Relapse is extremely common due to difficulties transferring gains made in the “action” phase of weight loss to the “maintenance” phase of weight loss. The action phase is where the rubber meets the road, so to speak (e.g., changing daily habits and routines, starting a nutritional plan, exercising). But the maintenance phase is where the road becomes a long stretch of highway called “healthy living”.

Ideally, the behavioral changes made during the action phase of weight loss coincide with greater education and awareness about the relationship between our thoughts, emotions, and lifestyle habits. For instance, research consistently finds that suppressing caloric intake (“I can’t eat more than 1,000 calories a day”) as well as thoughts about eating comfort foods (“Don’t think about cake or candy or chips or ice cream…”) actually increases food intake long-term. So while these strategies work temporarily, they ultimately have to be adapted into a system that is realistic in the daily grind of life.

Approaches that emphasize psychological skills like self-monitoring, emotion regulation, impulse control, intuitive eating, mindfulness, and stress management plus the behavioral weight loss components (recording physical activity and nutritional habits) are favored for long-term healthy weight management. The clinical health psychology program at NRS-Lifespan incorporates these principles and approaches into counseling. If you are interested in learning more, call our office at 732-988-3341 to schedule a consultation appointment with one of our clinical health psychologists.

Lauren Gashlin, Psy.D.
Clinical Health Psychologist
NJ License #5553

Stress is considered a global epidemic, affecting 350 million people worldwide and well recognized as a risk factor for various chronic conditions, including depression. Sources of stress range from daily “hassles” to major life events (e.g., serious accidents) and all involve a response to survive. The ability to effectively adjust requires us to alter our emotional responses to changing circumstances, which makes us psychologically flexible.

Unfortunately, adjustment is not always easy, especially for individuals who experience unhealthy, repetitive and negative thoughts (e.g., regrets about the past, self/other criticism). Dwelling on things is a risk factor for the development and maintenance of major depressive disorder (MDD). It is characterized by inflexible negative emotions. A common feature is brooding,  which also consists of unproductive thoughts such as “Why can’t I handle problems better?” or “Why do I feel this way?” Some people become stuck in their repetitive negative thoughts which undermines their ability to regulate and control emotions as they respond to stressors. This leads to unhealthy coping efforts (e.g., socially isolating, giving up) adversely affecting a person’s sense of control over their situation.

Deep breathing, also called diaphragmatic breathing, can break the vicious cycle of negative ruminative thinking, allowing an individual to regain control over their emotions when faced with stressors. A component of the mindfulness approach, deep breathing involves focusing attention on breathing, separate from repetitive thoughts. By detaching from negative thoughts, the individual focuses on the present, moment-to-moment experience, which induces calmness, peace, and relaxation. Any wandering thoughts are viewed as simply events occurring in the mind rather than representing a true reflection of how you truly feel. Thus, instead of changing the content of thoughts, you change your relationship to thoughts. Deep breathing represents a powerful self-control strategy. In fact, research findings support deep breathing practice as an intervention that significantly reduces repetitive thinking and associated depression, stress levels, and emotional reactions.

If you or a loved one is struggling with worry and/or depression, please call our office for consultation.

Basia Andrejko-Gworek, Ph.D.
Clinical Psychology, Post-Doctoral Fellow
Permit# TP #213-03

A controversial topic…. a neuropsychological review.

• Thanks to vaccinations and more widely available treatments, many patients who contract COVID-19 can avoid getting seriously ill, being hospitalized for treatment, or even dying.
• But even a symptom-free case of COVID can result in “Long COVID”, a condition that includes a wide range of symptoms from fatigue, difficulty thinking, behavior change, to a new diagnosis of diabetes or heart and lung problems.  People with Long COVID may be dealing with a single symptom or several at the same time.  The symptoms can last from days to weeks to months.
• The National Institute of Health (NIH) refers to long-term COVID-19, with many names.  One of them used here is Long COVID, and these patients are referred to as “long haulers.”
• The most common symptoms of Long COVID include fatigue, shortness of breath, cough, dizziness, palpitations, hair loss, gastrointestinal symptoms, heartburn, altered sense of smell and taste, and finally, brain fog, the area we shall focus upon here.
• Let’s review the research literature* investigating cognitive (thinking) functioning in patients with persistent complaints.  Persistent means a more chronic stage of recovery approximately 5.5 months after the COVID-19 diagnosis.  The studies showed mild cognitive deficits seen on neuropsychological testing that involved attention, processing speed, and organizational abilities.  The findings suggested that psychological factors and other persisting symptoms (example, sleep, fatigue) play a significant role in patients reporting thinking deficits in the long haulers of COVID-19.
• Thinking changes were found in patients during the acute or the early stage of the illness; however, the source of the thinking changes beyond five and a half months is unclear.  There were patients requiring higher levels of acute care who did not demonstrate greater cognitive deficits during comprehensive neuropsychological examination.  Nonetheless, findings are conflicting in the research.
• One possible explanation for the cognitive findings is that other factors such as mood difficulties, sleep dysfunction, and fatigue contribute to a person’s thinking.
• The most striking finding in many of the studies is that over 70% of patients had previously been diagnosed with depression or anxiety prior to the COVID-19 infection.  This high prevalence of prior psychological symptoms is consistent with previous findings in the clinical literature on COVID-19.
• The research suggests the importance of assessing and addressing psychological and cognitive symptoms in patients beyond five to six months.
• For “Long COVID”, there are many effective treatments for symptoms such as heart and lung-related issues, but fewer treatments for other COVID symptoms such as cognitive complaints and chronic fatigue have been established.
• There is no current specific treatment for Long COVID, and each symptom should be assessed and treated.  For example, the psychological changes of anxiety, depression, and PTSD – all possible symptoms – often respond well to available treatments such as medication and medical adjustment counseling focusing on compensatory strategies for the cognitive inefficiencies that patients experience.

Robert B. Sica, PhD, ABN
Board Certified, Neuropsychology
Principal and Director of NRS|LS

*Archives of Clinical Neuropsychology, Volume 37, Issue 4, June 2022, Pages 729-737

Post-traumatic stress disorder (PTSD) is considered a major health problem worldwide.  The aftermath and long-term effects of trauma often results in physical and behavioral difficulties.  The American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  Specific DSM-5 diagnostic criteria for PTSD is well established and supported by the National Center for PTSD.  Diagnostic criteria for PTSD is based on an individual who is exposed to a traumatic event that meets specific stipulations and symptoms from four symptom clusters including intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity.  Within those categories are eight (A-H) criteria.  Below is a brief explanation of all criteria A-H:

Criterion A:  The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.
Criterion B: The traumatic event is persistently re-experienced.
Criterion C: Avoidance of trauma-related stimuli after the trauma.
Criterion D: Negative thoughts or feelings that began or worsened after the trauma.
Criterion E: Trauma-related arousal and reactivity that began or worsened after the trauma.
Criterion F: Symptoms last for more than 1 month.
Criterion G: Symptoms create distress or functional impairment (e.g., social, occupational).
Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

Following the diagnosis of PTSD, an individual often benefits treatment interventions provided by a trained professional such as a psychologist, psychiatrist, or counselor.  During treatment, PTSD is often divided into four phases as noted below:

• Impact phase (addressing initial behavioral reactions)
• Rescue phase (period when an individual begins to accept aspects of trauma)
• Intermediate recovery phase (an individual begins to adjust to “normal” life experiences)
• Long-term reconstruction phase (period of learning and accepting the long-term effects of trauma)

In essence, it is imperative that an individual be diagnosed and treated as quickly as possible to minimize the potential adverse effects of trauma and to expedite a successful return to “normal” life experiences.  If you or a loved one is experiencing PTSD symptoms, please call our office for consultation.

Michael Raymond, PhD, ABN
Board Certified, Neuropsychology